Provider Demographics
NPI:1821062811
Name:ALLENGER, RHONDA (LSW)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:ALLENGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:ALLENGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 8391
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-0891
Mailing Address - Country:US
Mailing Address - Phone:509-850-0408
Mailing Address - Fax:
Practice Address - Street 1:2209 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9663
Practice Address - Country:US
Practice Address - Phone:509-850-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-397481041C0700X
WALW00005252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36588Medicare ID - Type Unspecified